Citation NR: 9704320
Decision Date: 02/11/97 Archive Date: 02/19/97
DOCKET NO. 94-43 533 ) DATE
)
)
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO) in
Roanoke, Virginia
THE ISSUE
1. Entitlement to service connection for Post-Traumatic
Stress Disorder (PTSD).
2. Entitlement to service connection for a conversion
hysteria disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
W.R. Steyn, Associate Counsel
INTRODUCTION
The veteran had active duty from April 1969 to January 1970.
This appeal arises from a January 1994 rating decision by the
RO which denied the veteran’s claim seeking entitlement to
service connection for PTSD.
On his substantive appeal, the veteran indicated that his
claim of service connection was for a conversion disorder.
This matter was clarified at a hearing held at the RO in
January 1995, namely that his claim included both issues -
service connection for PTSD and a conversion disorder. The
appeal was thereafter developed accordingly.
Although service connection was previously denied in May 1986
for an emotionally unstable personality and dysthymic
disorder, the 1986 denial did not specifically extend to the
disorders currently claimed by the veteran, namely PTSD and a
conversion disorder. Therefore, the issues currently on
appeal will be considered on a de novo basis.
REMAND
The veteran is seeking service connection for his psychiatric
disorder. His representative contends that he had
psychiatric problems in service and that his current disorder
is related to service. In regard to PTSD, the veteran has
claimed that his condition is attributed to daily beatings
from his drill instructor during training at Parris Island,
South Carolina. During his personal hearing, in January
1995, he identified the instructor as Staff Sgt. Bolsey (page
5). During the veteran’s induction examination, he reported
that he had nervous trouble. The physician noted that the
veteran had mild anxiety. During the actual induction
examination, the physician did not note any psychiatric
abnormalities.
In September 1969, the veteran was brought to a VA hospital
by his father. He had fallen the day before and “bumped his
head”. Questioning revealed that the veteran was severely
confused as to time and place. His memory for remote events
seemed to be fairly good, but for things occurring in the
previous 2-3 years, he was mixed up. After the workup, the
impression was that the veteran was suffering from “some kind
of a conversion reaction and may even have broke into an
acute psychotic episode.” The veteran was transferred to a
Naval Hospital.
At the Naval Hospital, a routine physical was given and
laboratory and neurological examinations were within normal
limits. An electroencephalogram was also done which was
normal. Regarding the veteran’s mental status, the patient
had no thought disorder, and exhibited no evidence of
psychosis, neurosis or organic brain disorder. His affect
showed some indifference and his mood was normal. He was
oriented as to time, place and person. The diagnosis was
retrograde amnesia due to hysterical conversion reaction that
existed prior to enlistment.
In December 1969, the veteran appeared before a Medical
Board. At that time, the diagnosis was emotionally unstable
personality and it was recommended that he be discharged from
service. The medical history noted by the Medical Board
shows that the veteran returned home during leave in
September 1969. He was supposed to have reported to the
Republic of Vietnam four days after his leave expired. The
veteran reportedly was concerned about “family problems” and
was in conflict about reporting for duty in the Republic of
Vietnam. He reportedly said that the Vietnam conflict was “a
waste”, and that he was “planning not to fight back if the
enemy attacked”. The veteran also reportedly complained of
“inhuman treatment” during recruit training. He stated that
he did not like to be “beat upon” by drill instructors.
After a period of evaluation and treatment, and a review of
the records, the diagnosis was emotionally unstable
personality.
The post-service medical records dated from 1993 to 1994 show
that clinical assessments were made at various times of
alcohol dependence, dysthymic disorder, major affective
disorder, bipolar disorder, adjustment disorder with mixed
emotions, and PTSD. Specifically, a July 1993 record refers
to PTSD symptoms as being secondary to abuse in the United
Stated Marine Corps.
In a December 1994 letter, Bradford Felker, M.D., a VA
physician, stated that the veteran had a current working
diagnosis of Type II bipolar disorder and alcohol dependence
in remission. He also stated that the veteran carried a
provisional diagnosis of PTSD. The veteran claimed that this
diagnosis was based on “in-human treatment” and beatings he
underwent while in basic training. The veteran also noted
experiencing a fall while on active duty which led to a
positive loss of consciousness. As a result, the veteran
claimed to suffer chronic anxiety, mood swings, nightmares,
and impulsive behavior with difficulty maintaining
relationships. At the time of the letter, the veteran was
also being evaluated for possible attention deficit
hyperactivity disorder, residual type.
The veteran’s VA outpatient treatment folder has not been
associated with the claims folder. In addition, the veteran
has never been afforded a VA psychiatric examination to
determine whether he meets all the criteria for PTSD.
A review of the record indicates that further development
remains to be accomplished. In particular, it does not
appear that the RO has attempted to verify the stressful
incidents related by the veteran with the Commandant of the
Marine Corps. The Board has determined that the RO should
forward to the Commandant information regarding the veteran’s
unit of assignment, including the veteran’s DA Form 20.
Although the veteran has provided some detailed information
regarding the claimed stressors, the RO should make an
additional request for information and forward this
information to the Commandant of the Marine Corps.
In adjudicating a claim for service connection for PTSD, the
Board is required to evaluate the supporting evidence in
light of the places, types, and circumstances of service, as
evidenced by the veteran's military records, and all
pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b);
38 C.F.R. § 3.304(f) (1995); see Hayes v. Brown, 5 Vet.App.
60, 66 (1993). Additionally, service connection for PTSD
requires medical evidence establishing a clear diagnosis of
the condition, credible supporting evidence that the claimed
inservice stressor actually occurred, and a link, established
by the medical evidence, between current symptomatology and
the claimed inservice stressor. See Zarycki v. Brown, 6
Vet.App. 91, 97 (1993).
In West v. Brown, 7 Vet.App. 70 (1994), the Court elaborated
on the analysis in Zarycki. In Zarycki, the Court held that
in addition to demonstrating the existence of a stressor, the
facts must also establish that the alleged stressful event
was sufficient to give rise to PTSD. Id. at 98-99. In West,
the Court held that the sufficiency of the stressor is a
medical determination, and therefore adjudicators may not
render a determination on this point in the absence of
independent medical evidence. Id. at 79. The Court also
held in West that a psychiatric examination for the purpose
of establishing the existence of PTSD was inadequate for
rating purposes because the examiners relied, in part, on
events whose existence the Board had rejected. Id. at 78.
Upon reviewing Zarycki and West, it appears that in
approaching a claim for service connection for PTSD, the
question of the existence of an event claimed as a
recognizable stressor must be resolved by adjudicatory
personnel. If the adjudicators conclude that the record
establishes the existence of such a stressor or stressors,
then and only then, the case should be referred for a medical
examination to determine the sufficiency of the stressor and
whether the remaining elements required to support the
diagnosis of PTSD have been met.
In view of the psychiatric symptoms and findings in service
as well as the post service evidence and argument, the Board
finds that additional development is warranted prior to final
appellate review.
The VA has a duty to assist a claimant in the development of
facts pertinent to his or her claim under 38 C.F.R. §
3.103(a) (1993). Fulfillment of the duty to assist the
appellant includes the procurement and consideration of any
relevant VA or other medical records. Ferraro v. Derwinski,
1 Vet.App. 326 (1991). The post-service medical records
dated from 1993 to 1994 show that the veteran was diagnosed
at various times with alcohol dependence, dysthymic disorder,
major affective disorder, bipolar disorder, adjustment
disorder with mixed emotions, and PTSD. The physician who
diagnosed the veteran with PTSD did so provisionally and it
is not clear whether that diagnosis is a final one or not.
These records, and any ongoing treatment records should be
obtained. Murincsak v. Derwinski, 2 Vet.App. 363 (1992);
Colvin v. Derwinski, 1 Vet.App. 171 (1991).
In light of the foregoing, and in order to fairly and fully
adjudicate the veteran’s claim, the issues of service
connection for PTSD and conversion disorder are REMANDED to
the RO for the following action:
1. The RO should take appropriate action
to contact the veteran and request the
names, addresses, and approximate dates
of treatment of all health care providers
who have treated him for psychiatric
problems prior to, during, and after
service. When the veteran responds and
provides any necessary authorizations,
the named health care providers should be
contacted and asked to submit copies of
all medical records documenting their
treatment which are not already in the
claims folder. All records obtained
should be associated with the claims
folder.
2 The RO also should obtain copies of
any records referable to VA outpatient
treatment received by the veteran, and
associate them with the claims folder.
3. The RO should request from the
veteran a comprehensive statement
containing as much detail as possible
regarding the stressors to which he
alleges he was exposed to during basic
training. The veteran should be asked to
provide specific details of the claimed
stressful events during service, such as
dates, places, detailed descriptions of
events and identifying information
concerning any other individuals involved
in the events, including their names,
ranks, units of assignment or any other
identifying detail. The veteran is
advised that this information is vitally
necessary to obtain supportive evidence
of the stressful events and that he must
be as specific as possible because
without such details an adequate search
for verifying information can not be
conducted.
4. With the additional information
obtained and the evidence currently of
record, the RO should review the file and
prepare a summary of all the claimed
stressors. This summary, together with a
copy of the DD 214 and the DA Form 20, or
equivalent, and all associated documents,
should be sent to the Commandment of the
Marine Corps, Headquarters, United States
Marine Corps, Code MMRB, Quantico,
Virginia 22134-0001. They should be
requested to provide any information that
might corroborate the veteran's alleged
stressors.
5. If, and only if, the RO determines
that the record establishes existence of
a stressor or stressors then the RO
should specify those stressors for the
record.
6. The RO should arrange for the veteran
to be accorded an examination by a board
of two VA psychiatrists, if available,
who have not previously examined him to
determine whether the veteran has PTSD
and/or a conversion disorder. In
determining whether or not the veteran
has PTSD due to an inservice stressor,
the examiners are hereby notified that
only the verified history detailed in the
reports provided by the Marine Corps
and/or the RO may be relied upon. The
claims folder, along with any additional
evidence requested above, should be
provided to the examiners for review.
The examination report should reflect
review of pertinent material in the
claims folder and include the complete
rationale for all opinions expressed.
All necessary special studies or tests,
to include psychological testing and
evaluation, such as the Mississippi Scale
for Combat-Related post- traumatic stress
disorders, should be accomplished. The
examiners should state whether the
diagnostic criteria to support the
diagnosis of PTSD have been satisfied.
If it is determined that the veteran has
a conversion hysteria disorder then the
examiners should comment upon whether
that disorder is related to service. The
report of examination should include the
complete rationale for all opinions
expressed.. As always, complete reasons
and bases for the conclusions reached
should be furnished.
7. The RO should then review the record
and the claim should be readjudicated.
If the determination remains adverse to
the veteran, both he and his
representative, should be provided a
supplemental statement of the case which
includes a summary of additional evidence
submitted, any additional applicable laws
and regulations, and the reasons for the
decision. The veteran and his
representative should be afforded the
applicable time to respond.
Thereafter, the claim should be returned to the Board for
further review. No action is required of the veteran until
he receives further notice. The Board does not indicate any
factual or legal conclusion as to any final outcomes
warranted in the appeal.
STEVEN L. COHN
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. § 20.1100(b)
(1995).
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